August 2014 Wills Eye Resident Case Series

Not long after a minor accident, a young man presents with swelling and tenderness in his cheek and concurrent tearing.

Presentation

A 32-year-old African-American male presented to an ophthalmology office with a chief complaint of persistent swelling and mild tenderness of the right cheek after mild accidental trauma six weeks prior. He described moderate concurrent tearing but denied any change in vision, diplopia, ocular pain, headache or constitutional symptoms including fever, chills or recent weight loss.

Medical History

Medical history was significant only for seasonal allergies for which he had received allergy desensitization injections in the past. He took no chronic medications, and his family history was noncontributory. The patient had moved from Liberia to the United States 20 years prior. He worked as a counselor in a city group home.

Examination

Vital signs were stable and within normal limits. Ocular examination revealed visual acuity of 20/25 in the right eye and 20/30 in the left eye. Pupils were equal and reactive without an afferent pupillary defect. Extraocular motility, confrontation fields and color plates were full in both eyes. Additionally, the intraocular pressure was normal on both the right and left side. Although swelling was evident along the right cheek and lower eyelid, Hertel exophthalmometry was 25 mm on the right and 25 mm on the left with a base of 107 mm. A firm mass was palpable along the right inferior orbital rim that produced some right-sided hyperglobus, and Krimsky testing confirmed no hypertropia (See Figure 1).

Figure 1. External photograph demonstrating swelling along the right cheek and a mass along the right inferior orbital rim causing hyperglobus.